Archive for the ‘Midface Lift Surgery’ Category
Facial cosmetic surgery is a very personal and monumental decision. Universally, all patients want the best outcomes. In today’s corporatized America, with heavily influential marketing spin, pharmaceutical companies, medical device companies, and even practitioners promote a less is more mentality to push products and services that often over promise and under deliver on the results. In no way can skin creams, injectables, or lasers deliver the types of results once can achieve with surgery. In a similar manner, minimally invasive sounding surgeries are in no way a substitute for time tested peer reviewed procedures that provide quality long lasting results.
Unfortunately not every person will achieve acceptable results with Botox or injectable fillers such as Juvederm, Restylane, and Radiesse. These products have their place in facial aesthetic practices, in properly selected patients, but in general should be viewed as temporary treatments with less impressive results when compared to surgery. Their primary advantage is that they have minimal social while providing a benefit. Botox is being used more and more as a preventative cosmetic medicine that delays wrinkle formation. Fillers camouflage initial signs of aging, but ultimately putting too much filler in a face, the liquid facelift, can alter ones appearance creating an artificial overinflated appearance. Using filler to augment facial structures can be useful to patients wanting to get a general idea of the appearance prior to permanent surgical procedures such as lip and cheek enhancements procedures. Creams reverse the signs of photo aging and contribute to collagen formation and production but are limited in their effectiveness. Lasers are an excellent option to delay the signs of aging and treat sun induced skin photoaging, but in no way can they tighten skin like facial cosmetic surgeries such as a facelift.
Surgical procedures are the best option for impressive endurable results. Rhinoplasty can dramatically affect ones facial appearance in a way that almost no other cosmetic surgery can. The nose can cause undue and unnecessary attention drawing attention away from other attractive facial features. Aging face surgery has many layers of effectiveness based on the surgical techniques used and how they are applied. In general, minimally invasive techniques can produce an artificial appearance and or short-term results. When considering aging face surgery most sophisticated patients are looking for surgeries that will last as long as possible with the most dramatic natural appearing results. There are no shortcuts to achieving optimal results and when applied, shortcut techniques frequently under deliver on the surgical results end.
Becoming an informed patient who understands the benefits of finding the right intervention or surgery for the right patient will ultimately save one time and money over the long haul. Getting things done right the first time is of paramount importance to achieving optimal outcomes with a high degree of patient satisfaction, while avoiding problems and bad outcomes.
Posted by: Benjamin C. Stong MD
Healing following Facelift surgery is of significant interest to patients and practitioners. Millions of dollars are spent on marketing every year, promising less healing and down time, and subsequently, a faster return to daily activities. Practitioners advertise minimally invasive surgical techniques and use prescription pharmaceuticals and homeopathic remedies to facilitate healing following surgery. Bromelain and Arnica Montana (A. Montana) are the two most common homeopathic treatments offered following facelift surgery; they are supposed to reduce swelling and bruising, respectively. One of the most conclusive studies on A. Montana demonstrated no difference in the degree of bruising between the group taking A. Montana and the group receiving a placebo pill following facelift surgery. However, this study did validate an objective computer model to assess bruising, with a superior ability to discriminate subtle color changes over the human eye and eliminating the inherent, subjective bias of visual analog scales and ranking schemes. This allowed the medical community to objectively study the effect of therapies on bruising following surgery, and in particular facelift surgery procedures.
Hyperbaric oxygen (HBO) therapy has been popularized in the main stream media through several celebrities for its anti-aging effects. In the scientific literature it has been demonstrated to hasten wound healing by promoting free radical scavengers, reducing cell damage, and increasing the oxygen delivery and blood supply to wound beds. For years, hyperbaric oxygen therapy has been used to facilitate healing in chronic, non-healing wounds. Ultimately, the common pathway in hyperbaric oxygen therapy is more rapid wound healing. A new, unique application for HBO therapy is to assist healing in facelift surgery.
We performed a prospective, controlled study on thirteen patients undergoing face lift surgery with six electing to undergo HBO therapy immediately before and after their face lift. Seven patients were entered into the control group and received no therapy. Any additional confounding factors were equal and accounted for. Statistical Analysis, digital photography and the previously validated objective computer model were used to assess the resolution of bruising postoperatively. The result was a statistically significant decrease in the degree of bruising in the HBO group over the control group on postoperative days 7 and 10, with a 35% and 30% reduction, respectively. There were no complications associated with the treatment group.
This is the first report of the benefit of HBO therapy on wound healing in cosmetic surgery. To date there has been no more compelling evidence for a particular adjunctive therapy to facilitate healing, with many of the current treatments having little scientific evidence supporting their use. The validated computer model in this study provides the scientific community an excellent resource to objectively measure the resolution of bruising and healing following surgery. Additionally, a larger number of patients enrolled in this study would empower the degree of effect on bruising and most likely become statistically significant sooner in the postoperative course.
When patients are choosing to undergo facelift surgery, they should educate themselves on therapies that do and do not work. This can often be difficult due to the current directed marketing strategies making promises that often go unfulfilled. What the patient truly needs is a consultation with a facial plastic surgeon in order to decipher and discuss the information. Hyperbaric oxygen therapy offers patients a statistically validated and scientifically studied adjunctive therapy to recover faster, following facelift surgery. HBO in otherwise healthy patient’s is a safe, innocuous therapy with little downside. Although it can potentially increase the overall cost associated with the surgery, it does offer patients seeking the most rapid recovery from facelifts a further treatment modality to employ in order to return to daily activities faster. Due to the proven benefits, HBO should be included in the discussion with patients undergoing facelift surgery as a potentially beneficial therapy in the healing process and may be applicable to other plastic surgery procedures such as the midface lift.
Posted by: Benjamin C. Stong MD
Atlanta, GA
A facelift is a procedure designed to restore the neck and the lower third of the face, evolving tremendously over the previous 40 years. The deep plane facelift went through several developmental stages and today serves as one of the very best facelift techniques to provide patients with a long term correction of the jaw line and excess skin and fat in the neck. Early facelift pioneers discovered the SMAS (muscular) layer of the face and its importance in facelift surgery. Releasing the SMAS layer allowed aggressive re-suspension of the facial soft tissues, correcting the jowls and defining of the jaw line. Next the “Bi-planer” facelift lifted and contoured the neck to remove the excess skin and fat in addition to releasing and suspending the SMAS layer. The “tri-planer” facelift was then developed, to mobilize the tissues of the midface below eyelids and treat the nasolabial folds. This technique resulted in a less than satisfactory midface correction. Finally, Hamra refined this technique into the Deep Plane Facelift, releasing the suspensory ligaments just below the midface resulting in a correction of the midfacial drop and a softening of the nasolabial folds in addition to the correction of the jaw line and neck. This offered a unique facelift procedure, because it was much more comprehensive than any technique previously described. Today many of the best facelift surgeons use a variation of this technique.
The deep plane face lift can now be combined with mini facelift incisions to provide the maximum amount of correction available with a single facelift procedure while using the smallest incisions. Many patients falsely believe that the “Deep Plane” facelift will result in longer healing times. In truth, there is actually less bruising and risk of hematoma than with other techniques. With the deep plane facelift the correction in the midface and nasolabial folds is less permanent than the correction of the neck and jaw line. It is not as effective as a separate endoscopic temporal midface lift as a midface lift procedure. Surgeons who perform the deep plane facelift have had specialized training in the technique because it requires an intricate knowledge of the anatomy of the soft tissues of the face and the facial nerve to achieve optimal outcomes and avoid complications.
When consulting about facelift surgery, the overall expenses in addition to the healing period are foremost considerations. Most informed patients are seeking to have a procedure that will offer the longest term and most complete correction, thereby decreasing the overall cost from unnecessary revision surgeries. The deep plane facelift is currently one of two “gold standard” procedures, to correct the aging jaw line and neck, the other being an extended Sub-SMAS facelift. It is the only procedure to offer a correction of the midfacial soft tissue drop and the nasolabial folds with a single procedure.
Facelifts are often combined with other procedures, including: upper and lower eyelid blepharoplasty and brow lifts for a “full facelift” surgery. In addition, a skin rejuvenation plan is important to add to surgical procedures to attain superior results. Laser surgery and medical grade skin care products are often combined to offer the state of the art in skin rejuvenation therapy. Consultation with an expert facial plastic surgeon is critical to developing a strategy to restore and preserve ones youth and beauty.
Benjamin C. Stong MD
Atlanta, GA
Today, the vast majority of surgeons perform lower eyelid blepharoplasty or eyelid lift techniques using a transconjunctival approach with fat removal and a skin pinch to rejuvenate the lower eyelid. Additionally laser treatments or chemical peels may be used to improve skin texture and smooth wrinkles. The evolution of this treatment resulted from concerns of postoperative ectropion or lower eyelid malposition associated with more traditional techniques and lack of familiarity with the measures required to prevent these complications. The transconjunctival approach makes an incision on the inside of the eyelid and while it is a safer approach in less experienced hands, it has also resulted in an incomplete lower eyelid and midface rejuvenation.
The characteristics of the aging process of the lower eyelid and midface include decent of the midface soft tissues and fat pad, elongation of the lower eyelid, pseudoherniation of fat from around the eye resulting in puffiness, formation of the tear trough deformity, and redundancy of the skin and muscle of the lower eyelid. The transconjunctival lower eyelid blepharoplasty with fat removal and skin pinch fails to address several of these issues. Removal of fat from around the eye can lead to a hollowed appearance of the lower eyelid and an abrupt transition from the lower eyelid to the midface that appears unnatural and artificial. Additionally, a skin pinch removal from the lower eyelid fails to remove the excess muscle underneath the skin and shorten the eyelid. When considered in whole there are several problems with this technique and it fails to address several of the issues that occur with age in the lower eyelid and midface.
The skin muscle flap blepharoplasty with fat transposition is the most contemporary technique available in lower eyelid blepharoplasty, and it corrects several of the issues that the transconjunctival blepharoplasty with fat removal and skin pinch fails to address. First, and most importantly, the fat from around the eye is conserved and repositioned in the tear trough (the groove that forms between the eyelid and the nose and midface) obliterating it and resulting in a smoother more natural transition between the lower eyelid and midface. The skin muscle flap blepharoplasty also removes muscle as well as skin for a more natural correction of the redundant soft tissue of the lower eyelid. When the eyelid is properly re-suspended during the procedure the risk of permanent post procedure ectropion is virtually eliminated.
Shortening the lower eyelid is best accomplished by performing a midface lift at the same time as the lower eyelid blepharoplasty. The medical literature supports that by adding a midface lift to a lower eyelid blepharoplasty more skin and muscle can be removed resulting in a shorter more youthful lower eyelid. Most midface lift techniques do not effectively release and re-suspend the soft tissues of the midface. When considering a midface lift it is important to find a surgeon who performs a transtemporal extended subperiosteal midface lift to ensure an excellent outcome. When performing a skin muscle flap blepharoplasty with fat transposition along with a midface lift the aging characteristics of the lower eyelid and midface are more completely addressed resulting in a natural, more complete periorbital and midface rejuvenation.
It is also important to consider adding a skin resurfacing procedure to improve wrinkles and skin texture and quality of the lower eyelid and finish the rejuvenation. This can be accomplished through either chemical peels or ablative laser procedures. Contemporary laser procedures allow for excellent skin resurfacing and rejuvenation with shorter healing periods when compared to chemical peels and more traditional laser procedures. The state of the art laser skin resurfacing techniques combine an epidermal laser peel with a fractionated deep dermal laser resurfacing to treat both superficial and deep wrinkles and brown spots. The Pearl Fusion procedure combines the Pearl and Pearl Fractional procedures to offer the most advanced laser technology while providing the safest outcomes.
Finding a plastic surgeon who understands how the different surgical techniques correct the aging characteristics of the lower eyelid and makes informed recommendations based on the patient’s particular issues is important to achieve superior outcomes and avoid complications. Midface lifts can correct the drop of the cheek soft tissues, efface the nasolabial folds, and shorten the lower eyelid. While a deep plane facelift can also lift the cheek soft tissues and smooth the nasolabial folds, the midface lift offers a greater effect and more permanent change to the midface soft tissues and nasolabial folds. Performing a skin muscle flap blepharoplasty with fat transpositions along with a midface lift offers the most complete periorbital and midface rejuvenation available today.
Benjmamin C. Stong MD
Atlanta, GA
The lower eyelids and midface are structures that should be considered together when planning rejuvenation procedures. There is a youthful transition from the lower eyelid that is lost with age resulting in a bulging lower eyelid and a trough, “a double contour deformity.” Proper restoration procedures must consider reconstructive principles when developing and perfecting techniques. Contemporary trends have moved away from making incisions just below the lash line in blepharoplasty to using incisions on the inside of the eyelid with fat removal and skin pinch excisions. The natural course of aging on the face results in a loss of facial fat volume and hollowing. The removal of fat from the lower eyelid can result in a sunken appearance. Contemporary techniques are now trending towards fat preservation and repositioning to conserve facial fat thus creating a natural transition between the lower eyelid and midface.
The aging process of the lower eyelid and midface is complex. The tear trough deformity is characterized by a fold that occurs between the bulging of the lower eyelid and upper cheek. Correction of this deformity requires a keen understanding of midface and lower eyelid anatomy. In the near future lower eyelid blepharoplasty will trend toward fat repositioning procedures to translocate the fat the bulges from the lower eyelid and orbit into the groove to create a natural youthful transition to the upper cheek. This can only be achieved through the incision below the lash line.
The nasolabial fold lies between the base of the nostril and the corner of the lip. It deepens with age due to dropping of facial fat pads. It is also one of the most difficult areas to correct. Because there are many procedures that attempt to address the issue, there is no perfect procedure. To date the two most effective procedures to lift the midface fat pads and smooth the nasolabial folds are the deep plane face lift and the transtemporal subperiosteal extended midface lift. The medical literature supports the idea that the effect of the deep plane face lift on the nasolabial fold is short when compared to its effect on the lower cheeks and neck. The extended transtemporal subperiosteal midface lift offers an anatomically advantageous procedure to effectively lift the central cheek area to reposition the facial fat pads to a more youthful position creating a more natural transition between the cheek and lower eyelid through very small incisions that are well camouflaged in the temporal hair. Many other attempts to perform midface lift surgery use the same access points but either ignore or inadequately release the soft tissues of the cheek, temple, and nasolabial folds leading to sub optimal results and early failure.
Others perform a midface lift through an incision in the lower eyelid and effectively release the tissues of the central midface, cheek, and nasolabial fold, but they uniformly fail to release the outer portions of the cheek and temple that results in tethering during repositioning and early decent to its original position with an unacceptably high rate of lower eyelid malposition. Expecting the lower eyelid, which should be considered a non load bearing structure, to support the weight of the midface can result in pulling the lower eyelid down, an unusual appearance, and problems with watery, dry eyes.
Optimal rejuvenation of the midface usually requires a lower eyelid blepharoplasty with fat preservation and repositioning with an extended transtemporal subperiosteal midface lift. Addressing the midface through traditional face lift incisions has been reported, but is not as effective at achieving maximal long term repositioning. There are several surgeries that are relevant to total midface rejuvenation. Except in younger people, rarely is the midface lift indicated as an isolated procedure. It can be performed in conjunction with a traditional face lift or brow lift procedure to avoid multiple surgeries and healing times. Performing safe effective midface surgery is challenging to even the most experienced surgeons. When considering a surgeon, understanding the procedure and how it will address a patient’s specific concerns is of paramount importance to meet expectations.
Post provided by: Midface Lift Surgery Atlanta GA | Benjamin C. Stong MD